Form Hud 903 PDF Details

The HUD 903 form serves as a critical instrument for individuals and organizations seeking to file complaints regarding housing discrimination under the enforcement of the U.S. Department of Housing and Urban Development's Office of Fair Housing and Equal Opportunity. This comprehensive document demands attention to detail, requiring respondents to either type or print their responses, ensuring clarity in the information provided. The estimated completion time of one hour reflects the thoroughness with which complaints must be articulated. Importantly, the form offers a structured pathway for complainants to articulate their encounters with discrimination, emphasizing the need for all questions to be addressed to the extent possible. Instructions guide users on how to proceed if certain pieces of information are unavailable or if questions seem inapplicable, indicating an understanding of the varied and complex nature of housing discrimination incidents. Signatures and dates are mandatory, embedding a layer of formal commitment to the information presented. Furthermore, the form accommodates multiple complainants in situations where the discriminatory act or policy affected several parties similarly, promoting efficiency in addressing widespread grievances. Prospective filers are also informed about where and how to submit their complaints, providing a clear route towards seeking resolution. Addressing discrimination based on race, color, religion, sex, handicap, familial status, or national origin, the HUD 903 form stands as a beacon for those who seek justice within the housing sector, embodying the tenets of the Fair Housing Amendments Act of 1988 by facilitating the registration of complaints aimed at curbing discriminatory practices and promoting equal housing opportunities for all.

QuestionAnswer
Form NameForm Hud 903
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other nameshousing complaint form, hud 903, hud 903 declaration, 903 declaration form blank

Form Preview Example

Housing Discrimination Complaint

U.S. Department of Housing

OMB Approval No. 2529-0011

and Urban Development

 

Office of Fair Housing

 

and Equal Opportunity

 

Please type or print this form

Public Reporting Burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Read this entire form and all the instructions carefully before completing. All questions should be answered. However, if you do not know the answer or if a question is not applicable, leave the question unanswered and fill out as much of the form as you can. Your complaint should be signed and dated. Where more than one individual or organization is filing the same complaint, and all information is the same, each additional individual or organization should complete boxes 1 and 7 of a separate complaint form and attach it to the original form. Complaints may be presented in person or mailed to the HUD State Office covering the State where the complaint arose (see list on back of form), or any local HUD Office, or to the Office of Fair Housing and Equal Opportunity, U.S. Department of HUD, Washington, D.C. 20410.

This section is for HUD use only.

Number

(Check the applicable box)

 

Jurisdiction

 

Signature of HUD personnel who established Jurisdiction

 

 

 

Referral & Agency (specify)

 

Yes

No

 

 

 

 

 

Systemic

 

Additional Info

 

 

 

 

Filing Date

 

 

 

 

 

 

Military Referral

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Name of Aggrieved Person or Organization (last name, first name, middle initial) (Mr.,Mrs.,Miss,Ms.)

 

Home Phone

 

Business Phone

 

 

 

 

 

 

 

 

Street Address (city, county, State & zip code)

 

 

 

 

 

 

 

 

 

 

 

 

2. Against Whom is this complaint being filed? (last name, first name, middle initial)

 

 

 

Phone Number

 

 

 

 

 

 

 

 

Street Address (city, county, State & zip code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check the applicable box or boxes which describe(s) the party named above:

 

 

 

 

 

 

 

Builder

Owner

Broker

Salesperson

Supt. or Manager

Bank or Other Lender

Other

If you named an individual above who appeared to be acting for a company in this case, check this box

and write the name and address of the company in this space:

Name:

 

Address

 

 

 

 

 

 

 

Name and identify others (if any) you believe violated the law in this case:

3. What did the person you are complaining against do? Check all that apply and give the most recent date these act(s) occurred in block No. 6a below.

Refuse to rent, sell, or deal with you

Discriminate in the conditions or terms of sale, rental occupancy, or in services or facilities

Other (explain)

Falsely deny housing was available

Advertise in a discriminatory way

Engage in blockbusting

Discriminate in financing

Discriminate in broker's services

Intimidated, interfered, or coerced you to keep you from the full benefit of the Federal Fair Housing Law

4.Do you believe that you were discriminated against because of your race, color, religion, sex, handicap, the presence of children under 18, or a pregnant female in the family or your national origin? Check all that apply.

Race or Color

 

Religion

 

Sex

 

Handicap

 

Familial Status

 

 

National Origin

 

 

Black

 

(specify)

 

 

Male

 

Physical

 

Presence of children

 

 

Hispanic

American

Other

White

 

 

 

 

Female

 

Mental

 

under 18 in the family

 

 

Asian or

Indian or

(specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

Pregnant female

 

 

 

Pacific

Alaskan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Islander

Native

 

5. What kind of house or property was involved?

Did the owner live there?

Is the house or property

 

What is the address of the house or property?

Single-family house

 

 

 

 

 

 

Yes

 

Being sold?

 

(street, city, county, State & zip code)

 

 

 

 

 

 

 

 

 

 

A house or building for 2, 3, or 4 families

 

 

 

 

No

 

Being rented?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A building for 5 families or more

 

 

 

 

 

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other, including vacant land held for

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

residential use (explain)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.Summarize in your own words what happened. Use this space for a brief and concise statement of the facts. Additional details may be submitted on an attachment.

Note: HUD will furnish a copy of the complaint to the person or organization against whom the complaint is made.

6a. When did the act(s) checked in Item

3 occur? (Include the most recent date if several dates are involved)

7.I declare under penalty of perjury that I have read this complaint Signature & Date (including any attachments) and that it is true and correct.

Previous editions are obsolete

Page 1 of 3

form HUD-903 (7/2001)

ref Handbook 8024.1

 

 

What Does the Fair Housing Amendments Act of 1988 Provide?

The Fair Housing Act declares that it is national policy to provide fair housing throughout the United States and prohibits eight specific kinds of discriminatory acts regarding housing if the discrimination is based on race, color, religion, sex, handicap, familial status or national origin.

1.Refusal to sell or rent or otherwise deal with a person.

2.Discriminating in the conditions or terms of sale, rental, or occu- pancy.

3.Falsely denying housing is available.

4.“Blockbusting”—causing person(s) to sell or rent by telling them that members of a minority group are moving into the area.

6.Discrimination in financing housing by a bank, savings and loan association, or other business.

7.Denial of membership or participation in brokerage, multiple listing, or other real estate services.

8.Interference, coercion, threats or intimidation to keep a person from obtaining the full benefits of the Federal Fair Housing Law and/or filing a complaint.

What Does the Law Exempt?

The first three acts listed above do not apply (1) to any single family house where the owner in certain circumstances does not seek to rent or sell it through the use of a broker or through discriminatory advertising, nor (2) to units in houses for two-to-four families if the owner lives in one of the units.

What Can You Do About Violations of the Law?

Remember, the Fair Housing Act applies to discrimination based on race, color, religion, sex, handicap, familial status, or national origin. If you believe you have been or are about to be, discriminated against or otherwise harmed by the kinds of discriminatory acts which are prohibited by law, you have a right, within 1 year after the discrimi- nation occurred to:

1.Complain to the Secretary of HUD by filing this form by mail or in person. HUD will investigate. If it finds the complaint is covered by the law and is justified, it will try to end the discrimination by conciliation. If conciliation fails, other steps will be taken to enforce the law. In cases where State or local laws give the same rights as the Federal Fair Housing Law, HUD must first ask the State or local agency to try to resolve the problem.

2.Go directly to Court even if you have not filed a complaint with the Secretary. The Court may sometimes be able to give quicker, more effective, relief than conciliation can provide and may also, in certain cases, appoint an attorney for you (without cost).

You Should Also Report All Information about violations of the Fair Housing Act to HUD even though you don't intend to complain or go to court yourself.

Additional Details. If you wish to explain in detail in an attach- ment what happened, you should consider the following:

1.If you fee that others were treated differently from you, please explain the facts and circumstances.

2.If there were witnesses or others who know what happened, give their names, addresses, and telephone numbers.

3.If you have made this complaint to other government agencies or to the courts, state when and where and explain what happened.

Racial/Ethnic Categories

1.White (Non Hispanic)—A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

2.Black (Non Hispanic)—A person having origins in any of the black racial groups of Africa.

3.Hispanic—A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Culture or origin, regardless of race.

4.American Indian or Alaskan Native—A person having origins in any of the original peoples of North America, and who maintains, cultural identification through tribal affiliation or community recog- nition.

5.Asian or Pacific Islander—A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Sa- moa.

You can obtain assistance (a) in learning about the Fair Housing Act, or (b) in filing a complaint at the HUD Regional Offices listed below:

For Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont:

NEW ENGLAND OFFICE (Marcella_Brown@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development Thomas P. O’Neill, Jr. Federal Building

10 Causeway Street, Room 321 Boston, MA 02222-1092

Telephone (617) 994-8300 or 1-800-827-5005 Fax (617) 565-7313 • TTY (617) 565-5453

For New Jersey and New York

New York/New Jersey Office (Stanley_Seidenfeld@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development 26 Federal Plaza, Room 3532

New York, NY 10278-0068

Telephone (212) 264-1290 or 1-800-496-4294 Fax (212) 264-9829 • TTY (212) 264-0927

For Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia

MID-ATLANTIC OFFICE (Wanda_Nieves@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development The Wanamaker Building

100 Penn Square East Philadelphia, PA 19107-9344

Telephone (215) 656-0662 or 1-888-799-2085 Fax (215) 656-3419 • TTY (215) 656-3450

Previous editions are obsolete

Page 2 of 3

form HUD-903 (7/2001)

ref Handbook 8024.1

 

 

For Alabama, the Caribbean, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee:

SOUTHEAST/CARIBBEAN OFFICE

(Gregory_L._King@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development Five Points Plaza

40 Marietta Street, 16th Floor Atlanta, GA 30303-2806

Telephone (404) 331-5140 or 1-800-440-8091 Fax (404) 331-1021 • TTY (404) 730-2654

For Illinois, Indiana, Michigan, Minnesota, Ohio, and Wiscon- sin:

MIDWEST OFFICE (Barbara_Knox@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development Ralph H. Metcalfe Federal Building

77 West Jackson Boulevard, Room 2101 Chicago, IL 60604-3507

Telephone (312) 353-7776 or 1-800-765-9372 Fax (312) 886-2837 • TTY (312) 353-7143

For Arkansas, Louisiana, New Mexico, Oklahoma, and Texas:

SOUTHWEST OFFICE (Thurman G. Miles@hud.gov or Garry_L._Sweeney@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development 801 North Cherry, 27th Floor

Fort Worth, TX 76102

Telephone (817) 978-5900 or 1-888-560-8913 Fax (817) 978-5876 or 5851 • TTY (817) 978-5595

For Iowa, Kansas, Missouri and Nebraska:

GREAT PLAINS OFFICE (Robbie_Herndon@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development Gateway Tower II

400 State Avenue, Room 200, 4th Floor Kansas City, KS 66101-2406

Telephone (913) 551-6958 or 1-800-743-5323 Fax (913) 551-6856 • TTY (913) 551-6972

For Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming:

ROCKY MOUNTAINS OFFICE (Sharon_L. _Santoya@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development 633 17th Street

Denver, CO 80202-3690

Telephone (303) 672-5437 or 1-800-877-7353 Fax (303) 672-5026 • TTY (303) 672-5248

For Arizona, California, Hawaii, and Nevada:

PACIFIC/HAWAII OFFICE (Charles_Hauptman@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development Phillip Burton Federal Building and U.S. Courthouse 450 Golden Gate Avenue

San Francisco, CA 94102-3448

Telephone (415) 436-8400 or 1-800-347-3739 Fax (415) 436-8537 • TTY (415) 436-6594

For Alaska, Idaho, Oregon, and Washington:

NORTHWEST/ALASKA OFFICE (Judith_Keeler@hud.gov)

Fair Housing Enforcement Center

U.S. Department of Housing and Urban Development Seattle Federal Office Building

909 First Avenue, Room 205 Seattle, WA 98104-1000

Telephone (206) 220-5170 or 1-800-877-0246 Fax (206) 220-5447 • TTY (206) 220-5185

If after contacting the local office nearest you, you still have questions – you may contact HUD further at:

U.S. Department of Housing and Urban Development Office of Fair Housing and Equal Opportunity

451 7th Street, S.W., Room 5204 Washington, DC 20410-2000

Telephone (202) 708-0836 or 1-800-669-9777 Fax (202) 708-1425 • TTY 1-800-927-9275

Privacy Act of 1974 (P.L. 93-579)

Authority: Title VIII of the Civil Rights Act of 1968, as amended by the Fair Housing Amendments Act of 1988, (P.L. 100-430).

Purpose: The information requested on this form is to be used to investigate and to process housing discrimination complaints.

Use: The information may be disclosed to the United States Depart- ment of Justice for its use in the filing of pattern or practice suits of housing discrimination or the prosecution of the person who commit- ted the discrimination where violence is involved; and to state or local fair housing agencies which administer substantially equivalent fair housing laws for complaint processing.

Penalty: Failure to provide some or all of the requested information will result in delay or denial of HUD assistance.

Disclosure of this information is voluntary.

For further information call the Toll-free Fair Housing Complaint Hotline 1-800-669-9777. Hearing Impaired persons may call (TDD) 1-800-927-9275.

Previous editions are obsolete

Page 3 of 3

form HUD-903 (7/2001)

ref Handbook 8024.1

 

 

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